Outbreaks of Haff syndrome, better known as black urine disease, in Amazonas and Bahia are being investigated by health authorities. According to the newspaper O Globo, there are 25 cases under analysis in the two states.
The place with the highest concentration of infected people is Itacoatiara, in Amazonas, where 19 people have already been diagnosed with the disease. Of these, seven are hospitalized at the José Mendes Regional Hospital, in Itacoatiara, and one person is hospitalized at the Doctor Heitor Vieira Dourado Tropical Medicine Foundation (FMT-HVD), in Manaus.
“All are hemodynamically stable and without any evidence of clinical complications. The seven patients hospitalized for observation remain”, explained the infectious diseases physician Antônio Magela, from FMT-HVD.
The most likely cause of the outbreak in the region is the ingestion of freshwater fish and shellfish. The syndrome, however, can also be a consequence of trauma, excessive physical activity, seizures, consumption of alcohol and other drugs.
In Bahia, there are six cases, concentrated in the municipalities of Alagoinhas, Simões Filho, Maraú, Mata de São João and Salvador.
“Foods are sent for laboratory analysis at a reference center and the investigation is deepened, as patients can present rhabdomyolysis for other causes”, said the director of the Epidemiological Surveillance of Bahia, Márcia São Pedro.
In 2020, Bahia had another outbreak of the disease, with 40 confirmed cases in the municipalities of Salvador, Feira de Santana, Camaçari, Entre Rios, Dias D’Ávila and Candiba.
Haff’s disease is associated with the ingestion of shellfish and fish and the main symptom is the darkening of the urine, which becomes coffee-colored. The syndrome can evolve quickly, the first symptoms appear between 2 and 24 hours after eating fish, and it mainly causes the breakdown of muscle cells.
In addition to black urine, the main signs of the disease include muscle pain and stiffness, numbness, loss of strength and shortness of breath.
The most accepted hypothesis is that the disease is caused by some thermostable biological toxin (that is, one that is not destroyed by the normal cooking process) present in freshwater fish and crustaceans.
The substance does not change the taste or color of the food, which facilitates contamination. Some seafood that has been consumed by patients diagnosed with the syndrome include species such as tambaqui, pacu-butter, pirapitinga and crayfish.
It is important that the disease is identified and treated quickly, as it can cause serious complications for the patient, such as renal failure, multiple organ failure and death.